BackgroundRadiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles.MethodsSemi-structured interviews (...) were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles.ResultsParticipants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier.ConclusionsMultiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views. (shrink)

Ulrich Beck's best selling Risk Society established risk on the sociological agenda. It brought together a wide range of issues centering on environmental, health and personal risk, provided a rallying ground for researchers and activists in a variety of social movements and acted as a reference point for state and local policies in risk management. The Risk Society and Beyond charts the progress of Beck's ideas and traces their evolution. It demonstrates why the issues raised by Beck reverberate widely throughout (...) social theory and covers the new risks that Beck did not foresee, associated with the emergence of new technologies, genetic and cybernetic. The book is unique because it offers both an introduction to the main arguments in Risk Society and develops a range of critical discussions of aspects of this and other works of Beck. (shrink)

According to a popular view, excuses undermine blameworthiness. At the same time, philosophers commonly accept that blameworthiness is composed of two necessary conditions: a moral objectionability condition and a responsibility condition. For excuses to do their job, they must undermine at least one of these conditions. In this paper, I conclude that excuses do neither. By inference to the best explanation, I propose a view that reconciles this conclusion with the function of excuses.

Marie van Loon | : In this paper, I argue that Alfred Mele’s conception of self-deception is such that it always fulfils the reasons-responsiveness condition for doxastic responsibility. This is because self-deceptive mechanisms of belief formation are such that the kind of beliefs they bring about are the kind of beliefs that fulfil the criteria for doxastic responsibility from epistemic reasons responsiveness. I explain why in this paper. Mele describes the relation of the subject to the evidence as a (...) biased relation. The subject does not simply believe on the basis of evidence, but on the basis of manipulated evidence. Mele puts forward four ways in which the subject does this. The subject could misinterpret positively or negatively, selectively focus, or gather evidence. Through these ways of manipulation, the evidence is framed such that the final product constitutes evidence on the basis of which the subject may believe a proposition that fits that subject’s desire that P. Whichever form of manipulation the subject uses, the evidence against P must be neutralized in one way or another. Successful neutralization of the evidence requires the ability to recognize what the evidence supports and the ability to react to it. These abilities consist precisely in the two parts of the reasons-responsiveness condition, reasons receptivity and reasons reactivity. In that sense, self-deceptive beliefs always fulfil the reasons-responsiveness condition for doxastic responsibility. However, given that reasons responsiveness is only a necessary condition for doxastic responsibility, this does not mean that self-deceived subjects are always responsible for their belief. | : Dans cet article, je soutiens que la conception d’auto-illusion chez Alfred Mele remplit toujours l’une des conditions de la responsabilité doxastique, à savoir la « sensibilité aux raisons ». Il en est ainsi car les mécanismes d’auto-illusion dans la formation de croyances produisent des types de croyances qui remplissent les critères pour la responsabilité doxastique quant à la sensibilité aux raisons épistémiques. J’explique pourquoi dans cet article. Mele décrit la relation du sujet à la preuve comme biaisée. Le sujet ne croit pas seulement sur la base de preuves, mais de preuves manipulées. Mele avance quatre façons qu’a le sujet de faire ceci. Le sujet peut mal interpréter positivement ou négativement, focaliser de façon sélective, ou accumuler des preuves. Par ces formes de manipulations, la preuve est formulée de sorte qu’elle produise un fondement pour la croyance en une proposition qui s’accorde avec le désir du sujet que P. Peu importe la forme de manipulation qu’emploie le sujet, la preuve contre P doit être neutralisée d’une façon ou d’une autre. Une neutralisation réussie de la preuve requiert la capacité de reconnaître ce que soutient la preuve et la capacité d’y réagir. Ces capacités consistent précisément en ces deux parties de la condition de la sensibilité aux raisons, soit la réceptivité et la réactivité aux raisons. En ce sens, les croyances d’auto-illusion remplissent toujours la condition de la sensibilité aux raisons pour la responsabilité doxastique. Toutefois, étant donné que la sensibilité aux raisons n’est une condition nécessaire que pour la responsabilité doxastique, cela ne veut pas dire que les sujets souffrant d’auto-illusion sont toujours responsables de leurs croyances. (shrink)

Health care organizations are constantly seeking ways to improve quality of care and one of the often-posed solutions to deliver ‘good care’ is reflexivity. Several authors stress that enhancing the organizations’ and caregivers’ reflexivity allows for more situated, and therefore better care. Within quality improvement initiatives, devices that guarantee quality are also seen as key to the delivery of good care. These devices do not solely aim at standardizing work practices, but are also of importance in facilitating reflexivity. In this (...) article, we study how quality improvement devices position the relationship between situated reflection and standardization of work processes. By exploring the work of Michel Callon, Michael Lynch, and Lucy Suchman on reflexivity in work practices, we study the development and introduction of the Care Living Plan. This device aimed to transform care organizations of older people from their orientation towards the system of care into organizations that take a client-centred approach. Our analysis of the construction of specific forms of reflexivity in quality devices indicates that the question of reflexivity does not need to be opposed to standardization and needs to be addressed not only at the level of where reflexivity is organizationally situated and who gets to do the reflecting, but also on the content of reflexivity, such as what are the issues that care workers can and cannot reflect upon. In this paper we point out the theoretical importance of a more detailed empirical study of the framing of reflexivity in care practices. (shrink)

It is widely believed that implicit bias is common and that it contributes, in part, to the perpetuation of systemic injustice. Hence, the existence of implicit bias raises the question: can individuals be blameworthy for their implicit bias? Here, I consider what it is about implicit bias that renders agents blameworthy. I defend the claim that, when individuals omit to engage in activities that could prevent the influence of implicit bias on their behavior, they may be blamed for their implicit (...) bias. The plausibility of my proposal depends on whether individuals are able to engage freely in such activities and on whether there exists an obligation not to be biased (broadly put). I will answer positively to the former question and open the way for an answer to the latter, and tougher, question. (shrink)

This article deals with the birth of `the virus' as an object of technoscientific analysis. The aim is to discuss the process of objectification of pathogen virulence in virological and medical discourses. Through a short excursion into the history of modern virology, it will be argued that far from being a matter of fact, pathogen virulence had to be `produced', for example in petri-dishes, test-kits and hyper-real signification-practices. The now commonly accepted objective status of `the virus' has been an accomplishment (...) of a complex ensemble of actors. Indeed, this illustrates why objectification rather than objectivity has become the main focus of science and technology studies. The objectification of `the' virus was by no means a smooth process. It involved more than five decades of highly speculative and fragmented research projects before it became actualized as a separate discipline under the heading of virology. The specific objectification of viruses took place through an inter-disciplinary de-differentiation of research questions, methodologies, techniques and technologies. The main argument of this article is that viruses only became intelligible after the establishment of a virology-assemblage. Its inauguration in the early 1950s was radical and sudden because only then could the various substrands of virological technoscience affect each other through deliberate enrolment, and engender a universal intelligibility. (shrink)

This article deals with the birth of `the virus' as an object of technoscientific analysis. The aim is to discuss the process of objectification of pathogen virulence in virological and medical discourses. Through a short excursion into the history of modern virology, it will be argued that far from being a matter of fact, pathogen virulence had to be `produced', for example in petri-dishes, test-kits and hyper-real signification-practices. The now commonly accepted objective status of `the virus' has been an accomplishment (...) of a complex ensemble of actors. Indeed, this illustrates why objectification rather than objectivity has become the main focus of science and technology studies. The objectification of `the' virus was by no means a smooth process. It involved more than five decades of highly speculative and fragmented research projects before it became actualized as a separate discipline under the heading of virology. The specific objectification of viruses took place through an inter-disciplinary de-differentiation of research questions, methodologies, techniques and technologies. The main argument of this article is that viruses only became intelligible after the establishment of a virology-assemblage. Its inauguration in the early 1950s was radical and sudden because only then could the various substrands of virological technoscience affect each other through deliberate enrolment, and engender a universal intelligibility. (shrink)

Network is a device for organizing and conceptualizing non-linear complexity. Networks defy narrative, chronology and thus also genealogy because they entail a multiplicity of traces. Networks problematize boundaries and centrality but intensify our ability to think in terms of flows and simultaneity. As a concept, network has been highly conducive to theorizing phenomena and processes such as globalization, digital media, speed, symbiosis and complexity. This in turn enables us to rethink what constitutes the foundations of intelligence, knowledge and even life (...) itself. One particularly useful application of network as a concept is the notion of the gift, which is often seen as the archetypical figure for understanding the nature of economics and social relationships. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vitoria, Cajetan, and the ConciliaristsKatherine Elliot van LiereFrancisco de Vitoria, professor of theology at the University of Salamanca from 1526 until his death in 1546, is widely recognized as the leader of the sixteenth-century scholastic revival and one of the foremost Catholic political thinkers of his day. His surviving relectiones (the lectures given in Salamanca at the end of each university term) cover a wide range of issues from (...) the morality of cannibalism to the legality of Henry VIII’s divorce. 1 Yet modern scholarly interest in Vitoria and his disciples (collectively known as “the School of Salamanca”) has focused mainly on issues relevant to the moral and legal problems of secular nation-states. Between this century’s two great wars Spanish and American scholars took a renewed interest in Vitoria’s published relectiones, seeing in them early expressions of the doctrine of international law, and arguing that Vitoria deserved some of the credit generally given to Hugo Grotius as the inventor of this concept. 2 Since then Spanish, American, and British scholarship on Vitoria and the School of Salamanca has continued to center mainly on such issues as just war, conquest, and slavery. 3 In the 1980s Anthony Pagden [End Page 597] revisited these questions, interpreting the School of Salamanca’s neo-Scholastic teachings as part of the “ideological armature of what [was arguably] the first early modern nation state.” 4 From a similar methodological perspective, Richard Tuck and Quentin Skinner have described the neo-Thomist revival of natural law as an important influence on the development of modern legal and political concepts like the subjective theory of natural rights and the Lockean contractual theory of political obligation. 5 Most recently, Pagden and Jeremy Lawrance have edited and translated into English a selection of Vitoria’s “political writings,” which will serve as a welcome aid for future research on any of these themes. 6Yet Vitoria’s end-of-term lectures in Salamanca also discussed a number of other themes apart from the political theory of secular states. Among these, the theme of the structure and power of ecclesiastical government has so far received less attention than it deserves. 7 Ecclesiastical power, or “the power of the Church,” was one of only two subjects to which Vitoria devoted two relectiones each (the other being the famous debate about Spanish rights to dominion in America). Vitoria delivered his two lectures on ecclesiastical government, both entitled De potestate ecclesiae, in 1532 and 1533. In 1534 he lectured on the closely related theme of “the power of the pope and the council” (De potestate papae et concilii). 8 Vitoria’s treatment, in these three lectures, of the authority of the Church, the pope, and the general council is worth examining more closely not only for the intrinsic interest of these issues but perhaps even more for the light it sheds on the formation of Vitoria’s thinking about secular political power. All three relectiones preceded the two famous Relectiones de indiis (“On the American Indians”) which Vitoria delivered in [End Page 598] 1538 and 1539. For churchmen like the Dominican Vitoria, ecclesiastical and secular political power were inextricably linked; theories posited in one sphere had implications in the other, and in some cases these implications proved politically or theologically awkward enough to force a thinker back to the drawing board. The political theories about the natural origins of secular political power which Vitoria articulated in the late 1530s in his Relectiones de indiis reflect this painful process. They were not only inspired by Vitoria’s awareness of the plight of the American Indians under Spanish colonial rule; they were also shaped by his protracted struggle with the theological implications of natural law theory, a struggle which can be observed in his lectures of the early 1530s on ecclesiastical power.Observing this intellectual struggle in Vitoria’s writing affords more than just one more illustration of how all political thought is rooted in particular social contexts. For Francisco de Vitoria stood at a particularly significant juncture in the history of political thought. The position he carefully defined in the 1530s was characterized by a strong emphasis on the distinction between... (shrink)

Bowers et al. express skepticism about deep neural networks (DNNs) as models of human vision due to DNNs' failures to account for results from psychological research. We argue that to fairly assess DNNs, we must first train them on more human-like tasks which we hypothesize will induce more human-like behaviors and representations.

Research on value congruence rests on the assumption that values denote desirable behaviors and ideals that employees and organizations strive to approach. In the present study, we develop and test the argument that a more complete understanding of value congruence can be achieved by considering a second type of congruence based on employees’ and organizations’ counter-ideal values. We examined this proposition in a time-lagged study of 672 employees from various occupational and organizational backgrounds. We used difference scores as well as (...) polynomial regression and response surface analyses to test our hypotheses. Consistent with our hypotheses, results reveal that counter-ideal value congruence has unique relations to employees’ trust in the organization that go beyond the effects of ideal value congruence. We discuss theoretical and practical implications of this expanded perspective on value congruence. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vitoria, Cajetan, and the ConciliaristsKatherine Elliot van LiereFrancisco de Vitoria, professor of theology at the University of Salamanca from 1526 until his death in 1546, is widely recognized as the leader of the sixteenth-century scholastic revival and one of the foremost Catholic political thinkers of his day. His surviving relectiones (the lectures given in Salamanca at the end of each university term) cover a wide range of issues from (...) the morality of cannibalism to the legality of Henry VIII’s divorce. 1 Yet modern scholarly interest in Vitoria and his disciples (collectively known as “the School of Salamanca”) has focused mainly on issues relevant to the moral and legal problems of secular nation-states. Between this century’s two great wars Spanish and American scholars took a renewed interest in Vitoria’s published relectiones, seeing in them early expressions of the doctrine of international law, and arguing that Vitoria deserved some of the credit generally given to Hugo Grotius as the inventor of this concept. 2 Since then Spanish, American, and British scholarship on Vitoria and the School of Salamanca has continued to center mainly on such issues as just war, conquest, and slavery. 3 In the 1980s Anthony Pagden [End Page 597] revisited these questions, interpreting the School of Salamanca’s neo-Scholastic teachings as part of the “ideological armature of what [was arguably] the first early modern nation state.” 4 From a similar methodological perspective, Richard Tuck and Quentin Skinner have described the neo-Thomist revival of natural law as an important influence on the development of modern legal and political concepts like the subjective theory of natural rights and the Lockean contractual theory of political obligation. 5 Most recently, Pagden and Jeremy Lawrance have edited and translated into English a selection of Vitoria’s “political writings,” which will serve as a welcome aid for future research on any of these themes. 6Yet Vitoria’s end-of-term lectures in Salamanca also discussed a number of other themes apart from the political theory of secular states. Among these, the theme of the structure and power of ecclesiastical government has so far received less attention than it deserves. 7 Ecclesiastical power, or “the power of the Church,” was one of only two subjects to which Vitoria devoted two relectiones each (the other being the famous debate about Spanish rights to dominion in America). Vitoria delivered his two lectures on ecclesiastical government, both entitled De potestate ecclesiae, in 1532 and 1533. In 1534 he lectured on the closely related theme of “the power of the pope and the council” (De potestate papae et concilii). 8 Vitoria’s treatment, in these three lectures, of the authority of the Church, the pope, and the general council is worth examining more closely not only for the intrinsic interest of these issues but perhaps even more for the light it sheds on the formation of Vitoria’s thinking about secular political power. All three relectiones preceded the two famous Relectiones de indiis (“On the American Indians”) which Vitoria delivered in [End Page 598] 1538 and 1539. For churchmen like the Dominican Vitoria, ecclesiastical and secular political power were inextricably linked; theories posited in one sphere had implications in the other, and in some cases these implications proved politically or theologically awkward enough to force a thinker back to the drawing board. The political theories about the natural origins of secular political power which Vitoria articulated in the late 1530s in his Relectiones de indiis reflect this painful process. They were not only inspired by Vitoria’s awareness of the plight of the American Indians under Spanish colonial rule; they were also shaped by his protracted struggle with the theological implications of natural law theory, a struggle which can be observed in his lectures of the early 1530s on ecclesiastical power.Observing this intellectual struggle in Vitoria’s writing affords more than just one more illustration of how all political thought is rooted in particular social contexts. For Francisco de Vitoria stood at a particularly significant juncture in the history of political thought. The position he carefully defined in the 1530s was characterized by a strong emphasis on the distinction between... (shrink)